
<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <title>问卷调查</title>
    <script src="https://code.jquery.com/jquery-3.1.1.min.js"></script>
    <style>
        input {
            outline: none;
        }

        .item_form_input::input-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        input::input-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        input::-webkit-input-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        input::-moz-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        input::-moz-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        input::-ms-input-placeholder {
            font-size: 34px;
            font-weight: 400;
            color: #999999;
            line-height: 81px;
        }

        .page_body {
            width: 100%;
            background-image: url(image/index_bg.png);
            background-size: 100% 100%;
            background-repeat: no-repeat;
            padding-top: 1px;
        }

        .input_form {
            margin-top: 700px;
        }

        .input_item {
            margin: 20px 80px 0;
            padding: 40px 20px;
            background: #EEF8F8;
            border-radius: 10px;
        }

        .input_item_tit {
            display: flex;
        }

        .item_tit_num {
            width: 45px;
            height: 45px;
            background: #5CBAB8;
            border-radius: 50%;
            color: #fff;
            font-weight: 600;
            font-size: 36px;
            text-align: center;
            line-height: 45px;
        }

        .item_tit_txt {
            font-weight: 600;
            font-size: 38px;
            color: #5CBAB8;
            line-height: 40px;
            margin-left: 12px;
        }

        .item_tit_txt_2 {
            font-size: 36px;
            color: #5CBAB8;
            line-height: 80px;
        }

        .input_item_cont {
            padding: 20px;
        }

        .item_cont_line {
            margin: 0px 69px;
            display: flex;
            justify-content: space-between;
            border-bottom: 1px solid #DAD8D8;
        }

        .item_cont_line_2 {
            margin: 0px 69px;
            display: flex;
            justify-content: space-between;
        }

        .item_form_input, .item_form_select {
            background-color: #EEF8F8;
            border: none;
            font-weight: 400;
            font-size: 34px;
            color: #999999;
            line-height: 81px;
            text-align: right;
        }

        .item_cont_radio {
            display: flex;
            align-items: center;
            font-weight: 400;
            font-size: 36px;
            color: #333333;
            line-height: 81px;
        }

        .item_form_radio {
            width: 30px;
            height: 30px;
            color: #999999;
            margin: 0 10px;
        }

        .cont_radio_div {
            display: flex;
            align-items: center;
            position: relative;
            margin-left: 40px;
        }

        .radio_name, .item_form_option {
            font-weight: 400;
            font-size: 34px;
            color: #999999;
            line-height: 81px;
        }

        .item_cont_name {
            font-weight: 400;
            font-size: 34px;
            color: #333333;
            line-height: 81px;
        }

        .item_cont_name_2 {
            font-weight: 400;
            font-size: 38px;
            color: #333333;
            line-height: 81px;
        }

        .radio_name_txt {
            font-weight: 400;
            font-size: 34px;
            color: #999999;
            line-height: 81px;
            margin-left: 54px;
        }

        input:checked {
            background-color: #15C18F;
        }

        input[type="radio"] {
            width: 34px;
            height: 34px;
            z-index: 99;
            opacity: 0;
        }

        input[type="checkbox"] {
            width: 34px;
            height: 34px;
            z-index: 99;
            opacity: 0;
        }

        label {
            position: absolute;
            left: 5px;
            top: 25px;
            width: 34px;
            height: 34px;
            border-radius: 50%;
            border: 1px solid #15C18F;
        }

        /*设置选中的input的样式*/
        /* + 是兄弟选择器,获取选中后的label元素*/
        input:checked + label {
            background-color: #15C18F;
            border: 1px solid #15C18F;
        }

        input:checked + label::after {
            position: absolute;
            content: "";
            width: 9px;
            height: 16px;
            top: 5px;
            left: 11px;
            border: 3px solid #fff;
            border-top: none;
            border-left: none;
            transform: rotate(45deg)
        }

        .page_bottom {
            padding-bottom: 560px;
        }

        .page_bottom_txt {
            font-size: 40px;
            font-weight: 400;
            color: #5CBAB8;
            text-align: center;
            line-height: 80px;
            opacity: 0.6;
        }

        .page_bottom_btn {
            width: 336px;
            height: 110px;
            background: linear-gradient(0deg, #09BAB4, #11EBD4);
            border-radius: 48px;
            font-size: 54px;
            font-weight: bold;
            color: #FFFFFF;
            line-height: 110px;
            box-shadow: 0px 2px 5px rgba(52, 228, 225, 0.29);
            margin: 40px auto;
            text-align: center;
        }

        .logo {
            width: 296px;
            height: 82px;
            position: absolute;
            top: 30px;
            left: 0;
        }

        .logo_img {
            width: 100%;
            height: 100%;
        }
    </style>
    <script src="images/jquery-3.6.0.min.js"></script>
</head>
<body>
<div class="page_body">
    <div class="input_form">
        <div class="logo">
            <image class="logo_img" src="image/logo.png"></image>
        </div>
        <div class="input_item">
            <div class="input_item_tit">
                <div class="item_tit_num">1</div>
                <div class="item_tit_txt">基本信息</div>
            </div>
            <form action="" method="post" id="form1">
                <div class="input_item_cont">
                    <div class="item_cont_line">
                        <div class="item_cont_name">姓名</div>
                        <input class="item_form_input" type="text" name="name" placeholder="请输入姓名"/>
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">性别</div>
                        <div class="item_cont_radio">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="item1" type="radio" name="gender" value="1"
                                       checked><label></label>
                                <span class="radio_name">男</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="item2" type="radio" name="gender"
                                       value="2"><label></label>
                                <span class="radio_name">女</span>
                            </div>
                        </div>
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">年龄</div>
                        <input class="item_form_input" type="text" name="age" placeholder="请输入年龄"/>
                    </div>
                    <!-- <div class="item_cont_line">
                         <div class="item_cont_name">单位</div>
                         <div class="item_cont_radio">
                             <select name="company" class="item_form_select">
                                 <option value="" class="item_form_option">请选择</option>
                                 <option value="银川分公司" class="item_form_option">银川分公司</option>
                                 <option value="吴忠分公司" class="item_form_option">吴忠分公司</option>
                                 <option value="石嘴山分公司" class="item_form_option">石嘴山分公司</option>
                                 <option value="中卫分公司" class="item_form_option">中卫分公司</option>
                                 <option value="固原分公司" class="item_form_option">固原分公司</option>
                                 <option value="直属单位" class="item_form_option">直属单位</option>
                                 <option value="机关本部" class="item_form_option">机关本部</option>
                             </select>
                         </div>
                     </div>-->
                    <div class="item_cont_line">
                        <div class="item_cont_name">手机号</div>
                        <input class="item_form_input" id="s" type="text" name="phone" placeholder="请输入电信手机号"/>
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">单位</div>
                        <div class="item_cont_radio">
                            <select name="cars" id="select" class="item_form_select">
                                <option value="0" class="item_form_option">请选择</option>
                                <option value="直属单位" class="item_form_option">直属单位</option>
                                <option value="银川分公司" class="item_form_option">银川分公司</option>
                                <option value="吴忠分公司" class="item_form_option">吴忠分公司</option>
                                <option value="固原分公司" class="item_form_option">固原分公司</option>
                                <option value="中卫分公司" class="item_form_option">中卫分公司</option>
                                <option value="石嘴山分公司" class="item_form_option">石嘴山分公司</option>
                                <option value="区公司本部" class="item_form_option">区公司本部</option>
                            </select>
                        </div>
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name"></div>
                        <div class="item_cont_radio">
                            <select name="company" id="val" class="item_form_select"><option value="0" class="item_form_option">请选择</option></select>
                        </div>
                    </div>
                </div>
            </form>
        </div>
        <script type="text/javascript">
            var select = document.getElementById("select");
            select.onchange=function(){
                var selvalue = select.value;
                var val = document.getElementById("val");
                switch(selvalue){
                    case "直属单位" : val.innerHTML="<option value=\"政企客户事业部\" class=\"item_form_option\">政企客户事业部</option><option value=\"采购供应链管理中心\" class=\"item_form_option\">采购供应链管理中心</option><option value=\"渠道销售服务部\" class=\"item_form_option\">渠道销售服务部</option><option value=\"智家业务运营中心\" class=\"item_form_option\">智家业务运营中心</option><option value=\"10000号客户服务运营中心\" class=\"item_form_option\">10000号客户服务运营中心</option><option value=\"云网运营事业部\" class=\"item_form_option\">云网运营事业部</option><option value=\"网信安全科技创新事业部\" class=\"item_form_option\">网信安全科技创新事业部</option><option value=\"政企云网支撑部\" class=\"item_form_option\">政企云网支撑部</option><option value=\"信创产业基地\" class=\"item_form_option\">信创产业基地</option><option value=\"数字生活与产品创新中心\" class=\"item_form_option\">数字生活与产品创新中心</option>";break;
                    case "银川分公司" : val.innerHTML="<option value=\"公司本部\" class=\"item_form_option\">公司本部</option><option value=\"北区分公司\" class=\"item_form_option\">北区分公司</option><option value=\"南区分公司\" class=\"item_form_option\">南区分公司</option><option value=\"西区分公司\" class=\"item_form_option\">西区分公司</option><option value=\"金凤分公司\" class=\"item_form_option\">金凤分公司</option><option value=\"西夏分公司\" class=\"item_form_option\">西夏分公司</option><option value=\"永宁分公司\" class=\"item_form_option\">永宁分公司</option><option value=\"灵武分公司\" class=\"item_form_option\">灵武分公司</option><option value=\"贺兰分公司\" class=\"item_form_option\">贺兰分公司</option><option value=\"宁东分公司\" class=\"item_form_option\">宁东分公司</option>";break;
                    case "吴忠分公司" : val.innerHTML="<option value=\"公司本部\" class=\"item_form_option\">公司本部</option><option value=\"盐池分公司\" class=\"item_form_option\">盐池分公司</option><option value=\"同心分公司\" class=\"item_form_option\">同心分公司</option><option value=\"青铜峡分公司\" class=\"item_form_option\">青铜峡分公司</option><option value=\"红寺堡分公司\" class=\"item_form_option\">红寺堡分公司</option><option value=\"利通区分公司\" class=\"item_form_option\">利通区分公司</option>";break;
                    case "固原分公司" : val.innerHTML="<option value=\"公司本部\" class=\"item_form_option\">公司本部</option><option value=\"西吉分公司\" class=\"item_form_option\">西吉分公司</option><option value=\"三营分公司\" class=\"item_form_option\">三营分公司</option><option value=\"隆德分公司\" class=\"item_form_option\">隆德分公司</option><option value=\"泾源分公司\" class=\"item_form_option\">泾源分公司</option><option value=\"彭阳分公司\" class=\"item_form_option\">彭阳分公司</option><option value=\"原州区分公司\" class=\"item_form_option\">原州区分公司</option>";break;
                    case "中卫分公司" : val.innerHTML="<option value=\"公司本部\" class=\"item_form_option\">公司本部</option><option value=\"沙坡头分公司\" class=\"item_form_option\">沙坡头分公司</option><option value=\"中宁分公司\" class=\"item_form_option\">中宁分公司</option><option value=\"海原分公司\" class=\"item_form_option\">海原分公司</option><option value=\"海兴分公司\" class=\"item_form_option\">海兴分公司</option>";break;
                    case "石嘴山分公司" : val.innerHTML="<option value=\"公司本部\" class=\"item_form_option\">公司本部</option><option value=\"大武口分公司\" class=\"item_form_option\">大武口分公司</option><option value=\"惠农分公司\" class=\"item_form_option\">惠农分公司</option><option value=\"平罗分公司\" class=\"item_form_option\">平罗分公司</option>";break;
                    case "区公司本部" : val.innerHTML="<option value=\"区公司本部\" class=\"item_form_option\">区公司本部</option>";break;
                    default : console.log("erro");
                }
            };
        </script>
        <div class="input_item">
            <div class="input_item_tit">
                <div class="item_tit_num">2</div>
                <div class="item_tit_txt">一般情况</div>
            </div>
            <form action="" method="post" id="form2">
                <div class="input_item_cont">
                    <div class="item_cont_line">
                        <div class="item_cont_name">身高（m）</div>
                        <input class="item_form_input" type="text" id="my_height" name="height" oninput="myHeight()"
                               placeholder="请输入身高">
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">体重（kg）</div>
                        <input class="item_form_input" type="text" id="my_weight" name="weight" oninput="myWeight()"
                               placeholder="请输入体重">
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">腰围</div>
                        <input class="item_form_input" type="text" name="yaowei" placeholder="请输入腰围"/>
                    </div>
                    <div class="item_cont_line">
                        <div class="item_cont_name">体重指数（BMI）</div>
                        <span class="radio_name" id="my_bmi"></span>
                        <input style="display: none" type="text" class="my_bmi" value="" name="my_bmi"/>
                        <span class="radio_name">kg/㎡</span>
                    </div>
                </div>
            </form>
            <div class="">
                <form action="" method="post" id="form3">
                    <div class="item_cont_line_2">
                        <div class="item_cont_name">父亲有无家族史</div>
                        <div class="item_cont_radio">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="f_ill_yse" type="radio" onclick="fatherIllNo()"
                                       name="f_ill" value="0" checked><label></label>
                                <span class="radio_name">无</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="f_ill_no" type="radio" onclick="fatherIllYse()"
                                       name="f_ill" value="1"><label></label>
                                <span class="radio_name">有</span>
                            </div>
                        </div>
                    </div>
                </form>
                <form action="" method="post" id="form4">
                    <div id="father_ill" style="display: none;">
                        <div class="item_cont_radio" style="margin-left: 50px;">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="father_gxy"
                                       value="1"><label></label>
                                <span class="radio_name">高血压</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="father_tnb"
                                       value="1"><label></label>
                                <span class="radio_name">糖尿病</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="father_zyb"
                                       value="1"><label></label>
                                <span class="radio_name">职业病</span>
                            </div>
                        </div>
                        <div style="margin-left: 90px;border-bottom: 1px solid #DAD8D8;">
                            <span class="radio_name">其他</span>
                            <input class="item_form_input" style="text-align: left;" type="text" name="father_qt"/>
                        </div>
                    </div>
                </form>
            </div>
            <div class="">
                <form action="" method="post" id="form5">
                    <div class="item_cont_line_2">
                        <div class="item_cont_name">母亲有无家族史</div>
                        <div class="item_cont_radio">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="m_ill_yse" type="radio" onclick="motherIllNo()"
                                       name="m_ill" value="0" checked><label></label>
                                <span class="radio_name">无</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" id="m_ill_no" type="radio" onclick="motherIllYse()"
                                       name="m_ill" value="1"><label></label>
                                <span class="radio_name">有</span>
                            </div>
                        </div>
                    </div>
                </form>
                <form action="" method="post" id="form6">
                    <div id="mother_ill" style="display: none;">
                        <div class="item_cont_radio" style="margin-left: 50px;">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="mother_gxy"
                                       value="1"><label></label>
                                <span class="radio_name">高血压</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="mother_tnb"
                                       value="1"><label></label>
                                <span class="radio_name">糖尿病</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="mother_zyb"
                                       value="1"><label></label>
                                <span class="radio_name">职业病</span>
                            </div>
                        </div>
                        <div style="margin-left: 90px;border-bottom: 1px solid #DAD8D8;">
                            <span class="radio_name">其他</span>
                            <input class="item_form_input" style="text-align: left;" type="text" name="mother_qt"/>
                        </div>
                    </div>
                </form>
            </div>
        </div>
        <div class="input_item">
            <div class="input_item_tit">
                <div class="item_tit_num">3</div>
                <div class="item_tit_txt">现存主要健康问题</div>
            </div>
            <form action="" method="post" id="form7">
                <div class="item_cont_line_2">
                    <div class="item_cont_name_2">现存主要健康问题</div>
                    <div class="item_cont_radio">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" id="n_ill_yse" type="radio" onclick="healthProblemNo()"
                                   name="h_problem" value="0" checked><label></label>
                            <span class="radio_name">无</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" id="n_ill_no" type="radio" onclick="healthProblemYse()"
                                   name="h_problem" value="1"><label></label>
                            <span class="radio_name">有</span>
                        </div>
                    </div>
                </div>
            </form>
            <div class="" id="health_problem" style="display: none;">
                <form action="" method="post" id="form8">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_gxy"
                                   value="1"><label></label>
                            <span class="radio_name">高血压</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxy_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxy_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form9">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_tnb"
                                   value="1"><label></label>
                            <span class="radio_name">糖尿病</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_tnb_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_tnb_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form10">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_gxb"
                                   value="1"><label></label>
                            <span class="radio_name">冠心病</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxb_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxb_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form11">
                    <div class="" style="margin-left: 50px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_mxzsx"
                                   value="1"><label></label>
                            <span class="radio_name">慢性阻塞性疾病</span>
                        </div>
                        <div class="item_cont_radio" style="margin-left: 160px;">
                            <div class="cont_radio_div">
                                <span class="radio_name_txt">用药情况</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_mxzsx_yy"
                                       value="1"><label></label>
                                <span class="radio_name">是</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_mxzsx_yy"
                                       value="0"><label></label>
                                <span class="radio_name">否</span>
                            </div>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form12">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_exzl"
                                   value="1"><label></label>
                            <span class="radio_name">恶性肿瘤</span>
                            <span class="radio_name_txt" style="margin-left: 22px;">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_exzl_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_exzl_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form13">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_ncz"
                                   value="1"><label></label>
                            <span class="radio_name">脑卒中</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_ncz_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_ncz_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form14">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_zyb"
                                   value="1"><label></label>
                            <span class="radio_name">职业病</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_zyb_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_zyb_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form15">
                    <div class="" style="margin-left: 50px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_yjp"
                                   value="1"><label></label>
                            <span class="radio_name">腰(椎)间盘突出</span>
                        </div>
                        <div class="item_cont_radio" style="margin-left: 160px;">
                            <div class="cont_radio_div">
                                <span class="radio_name_txt">用药情况</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_yjp_yy"
                                       value="1"><label></label>
                                <span class="radio_name">是</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_yjp_yy"
                                       value="0"><label></label>
                                <span class="radio_name">否</span>
                            </div>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form16">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_jzb"
                                   value="1"><label></label>
                            <span class="radio_name">颈椎病</span>
                            <span class="radio_name_txt">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_jzb_yy"
                                   value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_jzb_yy"
                                   value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form17">
                    <div class="" style="margin-left: 50px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_gnsxz"
                                   value="1"><label></label>
                            <span class="radio_name">高尿酸血症</span>
                        </div>
                        <div class="item_cont_radio" style="margin-left: 160px;">
                            <div class="cont_radio_div">
                                <span class="radio_name_txt">用药情况</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_gnsxz_yy"
                                       value="1"><label></label>
                                <span class="radio_name">是</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="radio" name="health_gnsxz_yy"
                                       value="0"><label></label>
                                <span class="radio_name">否</span>
                            </div>
                        </div>
                    </div>
                </form>

                <form action="" method="post" id="form18">
                    <div class="item_cont_radio" style="margin-left: 53px;">
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="checkbox" name="health_gxzz"
                                   value="1"><label></label>
                            <span class="radio_name">高血脂症</span>
                            <span class="radio_name_txt" style="margin-left: 22px;">用药情况</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxzz_yy" value="1"><label></label>
                            <span class="radio_name">是</span>
                        </div>
                        <div class="cont_radio_div">
                            <input class="item_form_radio" type="radio" name="health_gxzz_yy" value="0"><label></label>
                            <span class="radio_name">否</span>
                        </div>
                    </div>
                    <div style="margin-left: 90px;border-bottom: 1px solid #DAD8D8;">
                        <span class="radio_name">其他</span>
                        <input class="item_form_input" style="text-align: left;" type="text" name="health_qita"/>
                    </div>
                </form>
            </div>
        </div>
        <div class="input_item">
            <div class="input_item_tit">
                <div class="item_tit_num">4</div>
                <div class="item_tit_txt">生活方式</div>
            </div>
            <form action="" method="post" id="form19">
                <div class="input_item_cont">
                    <div class="item_tit_txt_2">Q1：体育锻炼频率（单选）</div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="tydlpl" value="1"><label></label>
                        <span class="radio_name">每天</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="tydlpl" value="2"><label></label>
                        <span class="radio_name">每周一次以上</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="tydlpl" value="3"><label></label>
                        <span class="radio_name">偶尔</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="tydlpl" value="4"><label></label>
                        <span class="radio_name">不锻炼</span>
                    </div>
                </div>
            </form>
            <form action="" method="post" id="form20">
                <div class="input_item_cont">
                    <div class="item_tit_txt_2">Q2：饮食习惯（多选）</div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="1"><label></label>
                        <span class="radio_name">荤素均衡</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="2"><label></label>
                        <span class="radio_name">荤食为主</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="3"><label></label>
                        <span class="radio_name">素食为主</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="4"><label></label>
                        <span class="radio_name">嗜盐</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="5"><label></label>
                        <span class="radio_name">嗜油</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="checkbox" name="ysxg[]" value="6"><label></label>
                        <span class="radio_name">嗜糖</span>
                    </div>
                </div>
            </form>
            <form action="" method="post" id="form21">
                <div class="input_item_cont">
                    <div class="item_tit_txt_2">Q3：吸烟情况（单选）</div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="xyqk" value="1"><label></label>
                        <span class="radio_name">每天从不吸烟</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="xyqk" value="2"><label></label>
                        <span class="radio_name">已戒烟</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="xyqk" value="3"><label></label>
                        <span class="radio_name">吸烟</span>
                    </div>
                </div>
            </form>
            <form action="" method="post" id="form22">
                <div class="input_item_cont">
                    <div class="item_tit_txt_2">Q4：饮酒频率（单选）</div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="yjpl" value="1"><label></label>
                        <span class="radio_name">从不</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="yjpl" value="2"><label></label>
                        <span class="radio_name">偶尔</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="yjpl" value="3"><label></label>
                        <span class="radio_name">经常</span>
                    </div>
                    <div class="cont_radio_div">
                        <input class="item_form_radio" type="radio" name="yjpl" value="4"><label></label>
                        <span class="radio_name">每天</span>
                    </div>
                </div>
            </form>
        </div>
        <div class="input_item">
            <div class="input_item_tit">
                <div class="item_tit_num">5</div>
                <div class="item_tit_txt">您对健康管理的诉求是：</div>
            </div>
            <div class="">
                <form action="" method="post" id="form23">
                    <div id="mother_ill">
                        <div class="item_cont_radio" style="margin-left: 50px;">
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="kpjz" value="1"><label></label>
                                <span class="radio_name">科普讲座</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="jnpx" value="1"><label></label>
                                <span class="radio_name">技能培训</span>
                            </div>
                            <div class="cont_radio_div">
                                <input class="item_form_radio" type="checkbox" name="xz" value="1"><label></label>
                                <span class="radio_name">巡诊</span>
                            </div>
                        </div>
                        <div style="margin-left: 90px;border-bottom: 1px solid #DAD8D8;">
                            <span class="radio_name">其他</span>
                            <input class="item_form_input" style="text-align: left;" type="text" name="jkgl_qita"/>
                        </div>
                    </div>
                </form>
            </div>
        </div>
        <div class="page_bottom">
            <div class="page_bottom_txt">到底啦！非常感谢您的参与！</div>

            <div class="page_bottom_btn" onclick="replacePage()">提交问卷</div>
        </div>
    </div>
</div>

</div>

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        }
        $.ajax({
            url: "http://localhost:8001/two",
            type: "POST",contentType: "application/json",
            dataType: "JSON",
            data: newData,
            success: function (data) {
                if (data.code == 200) {
                    window.location.href = "/result.html";
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<script>
    $(document).ready(function () {

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                $.ajax({
                    type: "POST",
                    dataType: 'json',
                    async: false,
                    data: {mobile_phone: mobi, type: 2},
                    url: "/t/public/index.php/sms2021/sendyzm2.html",
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